Do oropharyngeal throat packs prevent fluid ingestion during orthognathic surgery?

Powell, Kathlyn; Amin, Dina; Sesanto, Rae; Bryant, Ayesha S.; Kukreja, Promil; Waite, Peter D.

doi:10.1016/j.ijom.2021.07.011

Cited by 11 publications

(6 citation statements)

References 25 publications

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“…A study by Faro et al [ 26 ] concluded that throat packs can not prevent PON (32% vs. 36%, P = 0.765) or POV (24% vs. 24%, P = 1.000) but were resulted in worse sore throat (72% vs. 36%, P = 0.011) and postoperative dysphagia (60% vs. 12%, P < 0.001). Similarly, Powell et al [ 27 ] showed that there was no difference in the incidence of PONV when patients received throat packs (26.7% vs. 26.7%, P = 1.000).…”

Section: Resultsmentioning

confidence: 86%

“…The ongoing debate about throat packs is whether they can provide a physical barrier against blood and irrigation fluids and reduce the incidence of PONV. A study by Powell et al can address this question [ 27 ]. According to their study, no difference was found for the gastric contents aspirated by a gastric tube when throat packs were used during surgery.…”

Section: Discussionmentioning

confidence: 99%

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Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Gao,

Zhao,

et al. 2024

BMC Anesthesiol

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Introduction Postoperative nausea and vomiting (PONV) is one of the most common adverse events following orthognathic surgery. It’s a distressing feeling for patients and continues to be the cause of postoperative complications such as bleeding, delayed healing, and wound infection. This scoping review aims to identify effective PONV prophylaxis strategies during orthognathic surgery that have emerged in the past 15 years. Methods We searched Pubmed, Cochrane Controlled Register of Trials, and Embase from 2008 to May 2023. Studies meeting the following criteria were eligible for inclusion: (1) recruited patients undergo any orthognathic surgery; (2) evaluated any pharmacologic or non-pharmacologic method to prevent PONV. Studies meeting the following criteria were excluded: (1) case series, review papers, or retrospective studies; (2) did not report our prespecified outcomes. Results Twenty-one studies were included in this review. Pharmacological methods for PONV prevention include ondansetron and dexamethasone (3 studies), peripheral nerve block technique (4 studies), dexmedetomidine (1 study), pregabalin (2 studies), nefopam (2 studies), remifentanil (1 study), propofol (2 studies), and penehyclidine (1 study). Non-pharmacologic methods include capsicum plaster (1 study), throat packs (2 studies) and gastric aspiration (2 studies). Conclusions Based on current evidence, we conclude that prophylactic antiemetics like dexamethasone, ondansetron, and penehyclidine are the first defense against PONV. Multimodal analgesia with nerve block techniques and non-opioid analgesics should be considered due to their notable opioid-sparing and PONV preventive effect. For the non-pharmacological methods, throat packs are not recommended for routine use because of their poor effect and serious complications. More prospective RCTs are required to confirm whether gastric aspiration can prevent PONV effectively for patients undergoing orthognathic surgery.

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Section: Resultsmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Gao,

Zhao,

et al. 2024

BMC Anesthesiol

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“…The pros and cons of using OPTPs remain to be debated [ 2 , 4 , 5 ]. During general anesthesia, a comparative study between a group using OPTPs and a group abstaining from OPTPs reported a higher incidence and severity of sore throat in the group using OPTPs, although there are probably differences due to OPTPs insertion time and insertion method [ 2 , 9 ]. Compared with the group using OPTPs, another study has also reported that sore throat and dysphagia at 24 h postoperatively were significantly lower in the group abstaining from OPTPs, with no significant difference in PONV [ 2 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Survey on the Awareness of the Use of Oropharyngeal Throat Packs in Dental Anesthesia: An International Online Survey

Yamaguchi,

Tsukimoto,

Kuroda

et al. 2024

Cureus

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Introduction: Oropharyngeal throat packs (OPTPs) are frequently used to administer general anesthesia during oral surgery and dental procedures. However, the use of OPTPs has remained controversial, with concerns about their effectiveness, the potential for falling short of expectations, and the inherent risk of serious oversight in removing them. This study aimed to assess the awareness of dental anesthesiologists in the United States of America (USA) and Japan regarding the use of OPTPs. Methods: An online questionnaire was distributed to 41 dental anesthesia education facilities in May 2023 and responses were obtained from 32 facilities. Results: The responses to the questionnaire indicated that dental anesthesiologists in both the USA and Japan believe that using OPTPs during general anesthesia with airway securement is of significant importance, albeit with varying primary purposes for their application. In contrast, notable disparities were observed between the USA and Japan regarding the perceived importance and routine use of OPTPs during open-airway general anesthesia. In both countries, there is a common understanding that the residual risks of OPTPs are severe and that multiple preventive procedures are required. Conclusions: The present study showed that dental anesthesiologists in the USA and Japan believed that the use of OPTPs was generally necessary for dental anesthesia. However, there was a difference in awareness between Japan and the USA regarding the importance of OPTPs for open-airway general anesthesia. Therefore, there should be a consensus among dental anesthesiologists in Japan and the USA on using OPTPs during open-airway general anesthesia in the near future.

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“…Throat packing could serve as a physical barrier that effectively prevents the downward flow of irrigation fluid and blood from the oropharynx to the esophagus and stomach 22 . However, throat packing can cause postoperative throat pain, mucosal injury, inflammation, and accidental airway obstruction 23 , 24 . Moreover, the application of throat packs in EETS has not been reported in the literature, and the effect of throat packs on postoperative gastric contents in patients undergoing EETA remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound assessment of gastric contents and volume in patients undergoing endoscopic endonasal transsphenoidal surgery: a prospective observational study

Jia

He²,

Gao³

et al. 2023

Sci Rep

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Intraoperative ingestion of blood, cerebrospinal fluid, and irrigation fluid can lead to an increase in gastric volume, resulting in the potential risk of aspiration in patients after endoscopic endonasal transsphenoidal surgery (EETS). In this prospective observational study, we aimed to assess the volume of gastric contents in patients undergoing this neurosurgical procedure using ultrasound, and to determine the factors associated with volume change. Eighty-two patients diagnosed with pituitary adenoma were recruited consecutively. Semi-quantitative (Perlas scores: 0, 1 and 2) and quantitative (cross-sectional area, CSA) ultrasound assessments of the gastric antrum were performed immediately before and after surgery in the semi-recumbent and semi-recumbent right-lateral positions. Seven (8.5%) patients had antrum scores from preoperative grade 0 to postoperative grade 2; nine (11%) patients had antrum scores from preoperative grade 0 to postoperative grade 1. The mean ± standard deviation (SD) of increased gastric volume was 71.0 ± 33.1 mL and 236.5 ± 32.4 mL in postoperative grade 1 and 2 groups, respectively. Subgroup analysis showed that 11 (13.4%) patients (4 in grade 1 and all in grade 2) had postoperative estimated gastric volume > 1.5 mL kg−1 (mean ± SD 3.08 ± 1.67, range 1.51–5.01 mL kg−1). Logistic regression analysis revealed that older age, diabetes mellitus, and long surgical duration were independent risk factors for significant volume change (all P < 0.05). Our results showed a significant increase in gastric volume in some patients who underwent EETS. Bedside ultrasound measurements of gastric volume can be used to assess the postoperative aspiration risk, particularly in older diabetic patients with a longer surgical duration.

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Do oropharyngeal throat packs prevent fluid ingestion during orthognathic surgery?

Cited by 11 publications

References 25 publications

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Survey on the Awareness of the Use of Oropharyngeal Throat Packs in Dental Anesthesia: An International Online Survey

Ultrasound assessment of gastric contents and volume in patients undergoing endoscopic endonasal transsphenoidal surgery: a prospective observational study

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